PowerPoint Slideshow about 'Renal trauma management in the new millennium' - claus

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Trauma is the highest cause of mortality in Australian males and females between 1 and 44 years of age1. Renal injury occurs in up to 5% of major trauma; the kidney is the most commonly injured genito-urinary organ. The majority of renal trauma has historically been managed conservatively2, 4.

Advances in imaging and treatment modalities, and an emphasis on nephron preservation, has expanded conservative management options in high grade renal trauma2. However, conservative management of high grade injuries may be associated with complications and late surgery5.

A total of 226 renal injuries in 222 patients were identified. Blunt injury accounted for the majority of cases (94%)

52% of injuries were AAST

Grade III or greater, and

considered high grade.

26% Grade III

18% Grade IV

8.0% Grade V.

Mechanism of Renal Injuries (All and High Grade)

Aim

To examine the incidence, aetiologyand outcomes of contemporary management of renal trauma at South Australia’s major tertiary referral trauma hospital over a ten-year period.

Motor vehicle accidents (37%) and motor bike accidents (21%) were the most common cause of injury.

Complications occurred in ten patients (5.4%). One patient had a non-perfused kidney post embolization with persistent hypertension requiring delayed nephrectomy. One had a non-perfused kidney following nephron preserving surgery. Eight patients had a persistent urinoma (4.3%), of these 75% had not been appropriately imaged and 87% had not been stented. Three developed a peri-nephric abscess.

A delayed phase CT within 72 hours of injury is recommended in high grade injuries. This ensures adequate assessment of the collecting system5. In this cohort appropriate imaging was more likely to be performed in isolated injuries and those admitted under urological care.

There is controversy over stent or nephrostomy insertion to reduce risk of persistent urinoma1, 5. In this cohort persistent or infected urinoma was more common with incomplete staging or significant collecting system injuries not managed with early ureteric stent insertion.